Form M-W - Marshall County Occupational License Tax For Schools Questionnaire printable pdf download

MARSHALL COUNTY OCCUPATIONAL LICENSE TAX FOR SCHOOLS

QUESTIONNAIRE

Return To: Marshall County Occupational License Tax for Schools Office, 86 High School Rd., Benton, KY 42025

Phone: (270) 527-6759; Fax (270) 527-0804; E-mail:

jobeth.appleton@marshall.kyschools.us

INSTRUCTIONS: This form is to be completed and submitted to the above address by all businesses operating

within Marshall County, Kentucky, and shall be used for the purpose of establishing an account for reporting

Marshall County Occupational License Tax for Schools.

1. Business Name: ______________________________________________________________________________

2. Business Address: _____________________________________________________________________________

______________________________________________ Phone No. _________________ Fax ________________

3. E-Mail Address: _______________________________________________________________________________

4. Mail Address, if different from above: ______________________________________________________________

______________________________________________ Phone No. _________________ Fax _________________

5. Type of ownership: ( ) Individual; ( ) Partnership; ( ) Corporation; ( ) Other______________________________

6. If individual, list name, address, and social security number of owner ______________________________________

____________________________________________________________ Soc. Sec. No. ______________________

7. If partnership, list name, address, and social security number of each partner

____________________________________________________________ Soc. Sec. No. ______________________

8. Nature of business: ______________________________________________________________________________

9. Do you have, or will you have, employees working in Marshall County? ( ) Yes ( ) No

10. Do you have, or will you have, Marshall County residents employed in Marshall County? ( ) Yes ( ) No

11. Date that business first paid, or will pay, wages to employees in Marshall County: ____________________________

12. Name of previous owner of this business, if any: _______________________________________________________

13. Date you assumed ownership: ______________________________________________________________________

14. Accounting period: ( ) Calendar year – Dec. 31, or ( ) Fiscal year ended __________________/________________

Month

Day

15. Other Information: _______________________________________________________________________________

_______________________________________________________________________________________________

I hereby certify that all information and statements herein are true and correct.

_______________________________________/ ________________________________/ _________________________

Signature

Title

Date

__________________________________________________________________________________________________

FOR OFFICE USE ONLY

Identification No. _________________

Date account established: ________ Identification number reassigned from:_______________________

Date account closed: ____________ Identification number reassigned to:_________________________

Date reassigned: ______________________________________________________________________

Form M-W, Rev. 06/10

Form M-W - Marshall County Occupational License Tax For Schools Questionnaire